الفهرس 
Literature ReviewOnly 14 pages are availabe for public view
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Abstract
Traumatic brain injuries are among the most common causes of
disability, mortality, and hospitalization in intensive care units (ICU) around the
world (CDC, 2022). Most patients with traumatic brain injuries experience
alterations in the level of consciousness (LOC) for different periods. Altered
LOC is associated with adverse effects on normal functioning the longer the
length of altered consciousness, the sever the functional dysfunction, the
slower the recovery,and the poorer the prognosis (Sedghi et al., 2020). One of
the most serious problems among comatose patients is sensory deprivation. It
can cause different mental and perceptual problems and life-threatening
conditions for patients hospitalized in ICUs. Consequently, there is a strong
need to improve coma arousal after traumatic brain injury to prevent these
complications. Auditory stimulation is a kind of stimulation that can enrich the
environment to improve arousal and awareness state in patients with coma and
has been proved to be an effective method and widely used (Zhu et al., 2019 &
Stokes et al., 2018).
Purpose of the Study
The purpose of the current study is to examine the effect of direct
auditory stimulation program on coma arousal among patients with traumatic
brain injury.Research Design
A quasi experimental design (study / control) was utilized.
Setting
The research was carried out in the neurosurgical intensive care units, at
Menoufia University Hospital, Shebin El-Kom, Menoufia.
Sample
A convenient sample of sixty patients who were admitted to the
neurosurgical ICU of the university hospital of Menoufia University These
patients met the following criteria a) Aged between 18 and 65years, b)
Admitted to neurosurgical intensive care units, c) Patients who had Bispectral
index score more than 60. Patients were excluded to participate in this study if
they had any of the following conditions a) history of previous neurological
disorders or reduction of auditory function because those patients cannot
respond to the designed auditory stimuli; b) Non-traumatic coma, c) history of
cardiac arrest of longer than 4 minutes because their brain function may be
affected as a result of prolonged hypoxia, d) patients who have brain stem
infarction, e) auditory area radiological affection reflected by CT or MRI.
Instruments
In order to achieve the purpose of the present study the following
Instruments were used:I. A Semi Structured Demographic: Developed by the researcher to
collect data including patient’s age, gender and ICU length of stay from
patient’s clinical record.
II. Revised Trauma Score: to assess the absolute survival probability of
traumatic patient.
III. Bispectral Index: to assess depth of sedation and arousal using EEG
electrodes.
IV. Glasgow Coma Scale: to assess the depth and duration of impaired
consciousness and coma. Three aspects of behavior are independently
measured; motor responsiveness, verbal performance, and eye opening.
Ethical Consideration
The Research Ethics Committee at the Faculty of Nursing granted written
clearance to conduct the study and after the study purpose was explained to the
hospital director, the researcher was given official authorization to proceed. A
written/oral consent obtained from the patient’s family after informed about the
aim, procedure and benefits of the study. The researcher stated that participation
in the study was voluntary and they may leave the study at any time without
incurring any penalties. Coding the data and keeping it in a locked cabinet
helped ensure the confidentiality and anonymity of the patient information.Data Collection:
Data was collected over a period of 11 months. Subjects were recruited to
share in the study after 24 hours of ICU admission and stabilization of the
condition. The subjects were matched against the inclusion and exclusion
criteria of the study. The investigator dealt with the control group first who
received standard care provided by hospital including patient repositioning, eye
care, DVT prophylaxis and fluid &nutritional management to prevent
contamination of data. Study group received the direct auditory stimulation
program five sessions per day for five consecutive days along with the routine
hospital care.
Results:
The mean age of the experimental subjects and control group was (29.33
± 7.07 and 29.33 ± 7.07) years old respectively. Regard to gender, most
of the subjects in experimental and control group were males 90.0% and
86.7% respectively. Regarding the GCS, about 66.7% and 63.3% in
studied sample had 8-9 GCS respectively and about 33.3% and 36.7%
had 10-12 GCS respectively. There was no significant variation between
the studied sample regarding their demographics.
Glasgow Coma Scale mean score in the experimental group (13.40
±1.22) was significantly improved in comparison with control group
(9.90 ±1.47) after intervention (P <0 .001). The mean score of Bispectral Index Number in the experimental group
(86.26 ±7.29) was significantly improved in comparison with the control
group (73.06 ±7.01) after intervention (P< 0.001).
Experimental group had a significantly lower mean ICU length of stay in
days (9.630 ±2.59) in comparison with the control group (13.30 ±2.77),
following the intervention (P< 0.001).
A significant negative correlation between GCS score and age between
experimental and control group after intervention with r = -0.372 (P <
0.035) and r = -0.223 (P <0.236) respectively. In addition, there is a
significant negative correlation between Glasgow Coma Scale score and
ICU length of stay between experimental and control group after
intervention with r =0.179 (P < 0.345) and r = -0.559 (P <0.001)
respectively.
A significant negative correlation between Bispectral Index Number and
age between experimental and control group after intervention with
r = -0.603 (P < 0.000) and r = -0.277 (P <0.139) respectively. In addition,
there is a significant negative correlation between Bispectral Index
Number and ICU length o f stay between experimental and control
group after intervention with r = -0.571 (P <0.001) and r =-0.086
(P < 0.652) respectively.Conclusion: -
Based on the result of the current study, it can be concluded that direct
auditory stimulation program has a positive effect on Glasgow Coma Scale
Mean Score and Bispectral index number among patients with traumatic brain
injury.
Recommendations: -
Design clinical practice guidelines for nurses working in the ICU to use
auditory stimulation program as a routine care for comatose patients and also
findings of the current study will enable critical care nursesto be aware of the
prototype and variation in traumatic brain injury patients’ responses and thus
nurses can develop individualized interventions.
Implications of Nursing Practice: -
Organize regular in-service education courses to educate critical care
nurses about the practice of auditory stimulation program as partof their daily
routine care for TBI.
Implication for future research: -
Using Sensory Stimulation Assessment Measure (SSAM) scale to assess
arousal in the future studies instead of GCS whereas SSAM better detects slight
neurological improvements after auditory stimulation than the GCS.